Review Question - QID 213925

This patient has a large (>5cm), deep, high-grade soft-tissue sarcoma, consistent with liposarcoma. Wide resection and radiotherapy would be the most appropriate treatment for this patient.

Soft tissue tumors are often painless, large (>5cm), firm and deep. These features are concerning and these soft-tissues tumors should be treated with wide excision and radiotherapy, either before or after surgery. Conversely, some STS may be treated with radiation therapy. For example, well-differentiated liposarcomas, which behave similar to lipomas, are low-grade sarcomas that have low metastatic potential and may be treated with excision alone as recurrence rate is low.

Papagelopoulos et al. review the management of patients with soft tissue sarcomas of the extremities. They report an increase in limb-salvage techniques in recent years. They also comment on the utility of radiation and chemotherapy agents in supplementing oncology-related surgical treatment. They conclude that a multidisciplinary team approach with input from oncologists, pathologists, radiation oncologists, and orthopedic and plastic surgeons is necessary for the management of patients with soft tissue sarcomas of the extremities.

Zarrin-Khameh et al. review alveolar soft part sarcoma. They note the majority of patients have metastatic disease at the time of diagnosis and prognosis is generally poor. They conclude that wide surgical resection and metastectomy is recommended due the tumor's resistance to chemotherapy.

Figure A is the axial MRI image of a high-grade liposarcoma. Figure B is the histology of a dedifferentiated liposarcoma showing high-grade sarcoma

Incorrect Answers:
Answers 1-5: High grade STS with concerning features such as large (>5cm) and deep should be treated with wide excision and radiation therapy